Zika one year later: Is it going away?

Doctors remind everyone that summer brings mosquitos and not to forget that the Zika virus is still with us

Doctors remind everyone that summer brings mosquitos and not to forget that the Zika virus is still with us

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Doctors remind everyone that summer brings mosquitos and not to forget that the Zika virus is still with us

Doctors remind everyone that summer brings mosquitos and not to forget that the Zika virus is still with us

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Four new travel-related zika cases in South Florida have been reported by health officials as well as a new locally acquired Zika infection in Miami-Dade County.

Four new travel-related zika cases in South Florida have been reported by health officials as well as a new locally acquired Zika infection in Miami-Dade County.

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No one has contracted Zika virus from a mosquito in California, but hundreds of residents have been infected in other countries and then returned to the state.

No one has contracted Zika virus from a mosquito in California, but hundreds of residents have been infected in other countries and then returned to the state.

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Orange and Seminole County governments are readying to hire more staff to their respective mosquito control programs to prepare for the Zika virus in the summer months.

Orange and Seminole County governments are readying to hire more staff to their respective mosquito control programs to prepare for the Zika virus in the summer months.

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They’re known as Batman and Robin around the Orange County Administration Building because George Ralls and Christopher Hunter always seem to solve the difficult tasks. Opiod deaths and Zika are two of the issues for which they helped craft new strategies. Ralls, assistant county manager and public safety director, and Hunter, the public health director, also are ER doctors who work a shift once every weekend at ORMC.

They’re known as Batman and Robin around the Orange County Administration Building because George Ralls and Christopher Hunter always seem to solve the difficult tasks. Opiod deaths and Zika are two of the issues for which they helped craft new strategies. Ralls, assistant county manager and public safety director, and Hunter, the public health director, also are ER doctors who work a shift once every weekend at ORMC.

One year ago Sunday, a mosquito put South Florida in the international spotlight.

The first case of the mosquito-borne Zika virus in the mainland U.S. was confirmed in Miami-Dade County by public health officials on Jan. 15, 2016. The patient had been infected in another country and then traveled here.

As of this month, there are more than 1,200 cases statewide — 256 of them transmitted by local mosquitoes — although the number of new diagnoses began dropping in the fall, as cooler, drier weather cut the insect population.

So will we see the end of Zika in 2017?

It's hard to say.

Public health forecasters at the University of Florida say it's doubtful Zika is finished -- although exactly how long the virus may hang around, and whether it will spread to other parts of the state and nation, is uncertain.

Last year, neighborhoods in Wynwood, Little River and Miami Beach became the first spots in the nation, along with Puerto Rico, where people began contracting the Zika virus.

Ira Longini, a biostatistics professor at the University of Florida's College of Public Health and College of Medicine, predicts Zika transmission will continue in the Americas this year, with South Florida and Texas the most likely mainland U.S. hot spots. Both had locally transmitted Zika outbreaks last year.

Longini, whose mathematical models are used to steer vaccine development and disease prevention response, predicts Zika will become endemic here — meaning, it's a health risk South Floridians' will need to be aware of and deal with.

"It may be relatively rare but it will be around," said Longini. He does expect a downturn, though, until spring.

Other experts, however, say it's still too early to write Zika's next chapters.

Jonathan F. Day, a medical entomologist at University of Florida's Medical Entomology Laboratory in Vero Beach, said he's waiting until he sees if Zika survives Florida's winter before suggesting what will happen later this year, when mosquito populations rise in warmer, wetter months.

"The simple answer is we don't know right now," said Day, who in his 40 years studying skeeters has seen multiple subtropical viral outbreaks cycle in and out of Florida.

The Aedes aegypti mosquito, which carries Zika as well as similar tropical viruses, is one tough bug, though. Dried out Aedes eggs, dormant for months, can be revitalized and hatch with a quick moistening rain, Day said. A dengue outbreak in Key West, also spread by Aedes, survived through a 2009 winter into 2010, he said.

Day and others also are closely watching the Caribbean, and Central and South America, as cases brought back by travelers were the primary driver of South Florida's 2016 outbreak — and could continue to be, given our proximity and ties to these areas. Yet Zika epidemics in those countries may drop off this year, Day said, as more people there become immune because they already have been infected.

"We really don't know what to expect," agreed John C. Beier, professor and chief of the environment and public health division at the University of Miami Miller School of Medicine. "We always will be living with mosquitoes. Definitely all of South Florida is at risk. We had a bad time here with Zika."

Surprising and, in some cases, devastating new information about Zika steadily unfolded in 2016. Public health officials confirmed the virus could cause serious neonatal neurological damage -- primarily microcephaly, or an unusually small head, often accompanied by severe developmental problem when the infant was born.

It was discovered Zika could be transmitted by sex, unlike similar viruses spread by mosquitoes. And South Floridians learned they could be carriers and not even know it, as only one in five people infected show symptoms.

In late July, state health officials confirmed the first Zika cases transmitted by local mosquitoes in the Wynwood arts district near downtown Miami. Ultimately, the federal Centers for Disease Control issued warnings for pregnant women not to travel to four separate local transmission areas in Miami-Dade County. The last advisory was not lifted until Dec. 9.

"We've never seen anything like Zika before, nothing on the scale of what it does to the central nervous system," said Longini. "It's what makes the virus very serious." Routine vaccines and prevention methods for young women and mothers-to-be are needed, he said.

As of Wednesday, the Florida Department of Health had confirmed 1,024 travel-related and 256 locally acquired Zika cases over the past year. The travel cases include 167 from Broward, 61 from Palm Beach, and 320 from Miami-Dade counties.

There are 210 pregnant women among Florida's cases, with 108 having delivered. Three of those infants were born with microcephaly or other neurological complications, state health officials said. Florida is participating in the CDC Zika pregnancy registry, which follows infected mothers and their babies for one year after birth.

Dr. Lucy Chen, a dermatologist at University of Miami/Jackson Memorial Hospital, said the medical profession now knows it takes doctors and nurses from multiple specialties, working together, to fight Zika.

Chen is the lead author of a report, published Wednesday in the "New England Journal of Medicine," about the first locally transmitted Zika case in United States, involving a then- pregnant 23-year-old Miami woman. She went to the doctor on July 7, complaining of a fever, sore throat and rash.

The paper focuses on the odd pink bumps that were scattered across the patient's body. Chen was called in as a consultant and, along with the multidisciplinary team, determined the patient had Zika. Although the bumps are one of the virus' symptoms, along with fever and joint pain and red eyes, many dermatologists never have seen what the rash looks like, Chen said.

"We published the paper in order to describe it, to contribute to the medical literature," said Chen, who included photos with the article. Such information could speed up diagnosis and proper treatment, she said.

Multiple vaccine trials in a number of countries will begin this year. But Beier said it will be two to five years before anything is widely available to the public.

In the meantime, "the most important thing we can do is maintain good mosquito control," he said. "Some of the methods we are using now have not been proven effective for Zika. And some methods that we maybe should consider aren't being used now."

UM, through a $10 million CDC initiative being split among four Florida universities and managed by UF, will start working with Miami-Dade County mosquito control units this year to determine the best way to bust the Aedes aegypti.

Along with testing existing products, Beier said researchers also will try new approaches such as killing the bugs with toxic sugar bait or luring the females into special mosquito traps that trap and kill them as they lay eggs.

One of Beier's major concerns for the new year, however, is that the public will let down its guard now that Zika no longer is daily news.

"People have to be aware," he said. "And they have to do everything to protect themselves."